Provider Demographics
NPI:1659811685
Name:MKRTCHYAN, PARUYR
Entity Type:Individual
Prefix:
First Name:PARUYR
Middle Name:
Last Name:MKRTCHYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8523 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3456
Mailing Address - Country:US
Mailing Address - Phone:818-378-7017
Mailing Address - Fax:
Practice Address - Street 1:8523 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3456
Practice Address - Country:US
Practice Address - Phone:818-378-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608811171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor